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Approximately 30% of patients who elect to have epidural anesthesia during labor experience hypotension, potentially causing complications for both mother and fetus. We evaluated whether lower limb compression at the time of epidural would decrease maternal hypotension.
Study Design: A single site randomized controlled trial was conducted. Upon informed consent, 240 term singleton parturients requesting epidural were recruited and randomized into 1 of 2 study arms: control or sequential compression device (SCD). Patients were excluded for diagnosis of hypertension, cardiovascular disease, or major fetal anomalies. Upon epidural request, intravenous fluid hydration was administered. SCDs were placed immediately prior to epidural placement and maintained for one hour following. Blood pressures were evaluated at 1, 5, 15, 30, 45, and 60 minutes following epidural bolus. Maternal hypotension was defined as a decrease in either mean arterial pressure (MAP), systolic (SBP), or diastolic blood pressure (DBP) of greater than 20% from the patient’s baseline. Statistical analyses included Student’s t-test (unpaired) and Chi-Squared tests for categorical variables. Statistical significance was defined as p< 0.05.
Results: Data from 218 of 240 recruited patients were analyzed: 111 control and 107 SCDs. A statistically significant difference was observed in DBP measurements with the control group having a higher occurrence of (6.8 ± 14.3 %) of hypotensive readings compared to that of the SCD group (3.3 ±9.6%; p=0.036). Pooled results for all BP parameters (DBP, SBP, and MAP) observed that the control group had an average occurrence of (6.3 ± 8.2 %) hypotensive events compared to that of the SCD group of 4.3 ±6.0%; p=0.058). No statistically significant differences were observed in secondary clinical outcomes including post-epidural fluid bolus or administration of vasopressors for refractory hypotension.
Conclusion:
Lower limb compression using SCDs significantly decreased the incidence of maternal hypotension in laboring patients who receive epidural anesthesia.
Laura M. Mroue, MD (she/her/hers)
Fellow
University of Arizona and Banner University Medical Center Tucson
Detroit, MI, United States
Haseeb Khan, DO
Fellow
Hutzel Hospital/Detroit Medical Center
Detroit, MI, United States
Mohamad Alkhatib, MD
Resident
Detroit Medical Center
Detroit, MI, United States
Lark Steafo, BS
Medical Student
Detroit Medical Center
Detroit, MI, United States
Noora Alkhalidi, MD
Detroit Medical Center
Detroit, MI, United States
George McKelvey, PhD
Research Associate
Detroit Medical Center
Detroit, MI, United States
Megan Steinmetz, MD
Ascension Medical Group
Oshkosh, WI, United States
Justin Hruska, MD
Detroit Medical Center
Detroit, MI, United States
Jeffrey R. Johnson, MD
Hutzel Hospital/Detroit Medical Center
Detroit, MI, United States